WIFE/MOTHER PERSONAL INFORMATION

Full Name

Street Address

City, State

Zip, County

Date of Birth

Maiden Name

Marriage #

Home Phone

Work Phone

Social Security #

HUSBAND/FATHER PERSONAL INFORMATION

Full Name

Street Address

City, State

Zip, County

Date of Birth

Maiden Name

Marriage #

Home Phone

Work Phone

Social Security #

MARRIAGE DETAILS

City/Town of Marriage

State of Marriage

Zip Code, County

Date of Marriage

Street Last Lived Together

City/Town Last Lived Together

State Last Lived Together

Zip Code, County Last Lived Together

Date Last Lived Together

PREVIOUS ATTORNEY(if applicable)

Name of Previous Attorney

Firm Name

Address

Telephone Number

DIVORCE CASES ONLY

Wife's Full Maiden Name

Wife's Previous Married Name

Full Name Wife Wishes to Resume

CHILDREN

Total Number Of Children Born or Adopted Into This Marriage/Relationship

Number of Minor Children of This Marriage/Relationship Living With Client

If There Are Any Present or Previous Court Actions Concerning Any of the Children, Enter the Date, Names of Courts, Docket Numbers of the Cases and the Outcome or Present State of Each Action Below:

How much does the custodial parent spend each year on child care (day care, sitters, camp, etc.) to enable him or her to be free to obtain employment?

If the non-custodial parent provides group health/medical insurance for the child(ren) through his or her employment, how much is deducted each week from the non-custodial parent's gross pay, to pay for this insurance?

If the non-custodial parent provides child support for a previous family, or if an amount is deducted from his or her salary to pay for a prior child or children, how much is paid or deducted each week?

What is the age of the oldest minor (under 18) child of this family?

How many children of this marriage/relationship are 18-23 years of age and are they going to school or otherwise dependant on their parents for support?

Full Name

Date of Birth

Living With (Mother/Father)

Childrens Current Address:

Other Address (within last two years):

Full Name

Date of Birth

Living With (Mother/Father)

Childrens Current Address:

Other Address (within last two years):

Full Name

Date of Birth

Living With (Mother/Father)

Childrens Current Address:

Other Address (within last two years):